Document Review Worksheet for the Comprehensive Success Review
VII. School Environment
School: ______________________
Evidence Source
School Success Plan
Date___________
Evidence Details
 Behavioral, social-emotional, physical health, nutrition, physical
activity, cultural and intellectual needs are considered in the
needs assessment and addressed as needed, with strategies
(VII.6, VII.7))
 Mission and Vision promotes students’ success beyond academics
(VII.1)
 High expectations for students and staff is explicit (VII.1, VII.2)
 Non-academic data (behavior, nurse, nutrition, fitnessgrams,
ATOD, climate surveys) indicate improvement (VII.3, VII.6, VII.7)
 Team members include counselors, nurses, school bus drivers,
custodians, and cafeteria supervisors (VII.4, VII.5)
 Behavior referral data for classroom, non-classroom and bus are
shared and improvement strategies discussed (VII.5)
 Drug related referral data are shared and improvement strategies
discussed (VII.5)
Reviewer: _________________
Comments
School Success Team
Agendas and Minutes
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 1 of 8
Evidence Source
Evidence Details
 Behavioral, social-emotional, physical health, nutrition, physical
activity, cultural and intellectual needs are addressed (VII.1)
 Student academic and non-academic successes are recorded
(VII.3)
Comments
Student Success Plans
Student/Parent
Handbook
 High expectations for students and staff is explicit (VII.1, VII.2)
 Details how students will be celebrated for academic and nonacademic successes (VII.3)
 Safe, healthy and drug-free environment policies and procedures
are included(VII.4, VII.5)
 Policies and procedures include tiered student assistance for
behavior concerns and physical health, nutrition, and physical
activity needs (VII.5, VII.7)
 Policies include tiered student assistance, counseling, and referral
procedures for students with social-emotional needs (VII.6)
 High expectations for students and staff is explicit (VII.1, VII.2)
 Expectations for teacher collaboration is evident (VII.2)
 Policies include tiered student assistance, counseling, and referral
procedures (VII.7)
Staff Handbook
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 2 of 8
Evidence Source
Common Planning Time
– Agenda, Attendance,
Meeting Notes
Crisis and Behavior
Plans
Evidence Details
 Individual student behavior data is shared and improvement
strategies discussed (VII.4, VII.5)
 Multiple data sources are discussed to evaluate and inform
practices and promote pro-social behavior and prevent problem
behaviors (VII.5)
Comments
 Plans are clearly written, including implementation and
enforcement procedures, updated and revised as indicated in
plan (VII.4)
 List of team members indicate all stakeholders, including
community, parents, administrators, teachers, counselor, nurse,
cafeteria supervisor, custodian, school bus driver,
paraprofessional and students are part of the plan development
and monitoring (VII.4)
 Behavior Plans include identification, prevention, and
intervention procedures for student inappropriate behaviors in
classroom, non-classroom areas, and on school buses (VII.5)
 Behavior Plans include tiered student assistance, counseling, and
referral procedures (VII.5)
 Behavior Plans include a schedule for actively teaching students
appropriate behaviors in classrooms, non-classroom areas, and
on school buses (VII.5)
 Behavior Plans include reinforcement activities and schedules for
rewarding students for positive behaviors (VII.5)
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 3 of 8
Evidence Source
Drug-free School Plan
Evidence Details
 Plans are clearly written, including implementation and
enforcement procedures, updated and revised as indicated in
plan (VII.5)
 List of team members indicate all stakeholders, including
community, parents, educators, and students are part of the plan
development and monitoring (VII.5)
Comments
 Attendance of all stakeholders, including community, parents,
teachers, counselor, nurse, cafeteria supervisor, custodian, school
bus driver, paraprofessional and students (VII.1, VII.4, VII.5)
School Success Plan,
Crisis Plan, Behavior
Plan, Drug-free School
Plan Meeting Sign-in
Sheets
PD Agendas,
Presentation
Handouts/Power
Points, Sign-in Sheets
 All staff attend strengths-based professional development
sessions focused on tiered supports and interventions for
supporting students with behavior concerns (VII.5)
 All staff attend strengths-based professional development
sessions focused on interventions to address students’ social and
emotional needs (VII.6)
 All staff attend strengths-based professional development
sessions focused on identification, prevention and intervention of
physical health and activity and nutritional needs (VII.7)
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 4 of 8
Evidence Source
Scope and Sequence
and Sample of
Units/Lessons/
Assessments,
Assessment Data and
Instructional Materials
for Each Grade
Evidence Details
 Lesson plans are developed for teaching students appropriate
behaviors in classrooms, non-classroom areas, and on school
buses (VII.4)
 Lesson plans are developed for teaching students how to ask for
help and cope with social and emotional concerns (VII.6)
 Lesson plans are developed for teaching physical health and
activity and nutritional practices (VII.7)
Comments




Posters, bulletin boards
and other postings in
the school
High expectations for students and staff is explicit (VII.1, VII.2)
Student exemplary academic work is displayed (VII.3)
Students are celebrated for non-academic successes (VII.3)
Teachers, staff, volunteers, administrators, parents, and
community successes are acknowledged (VII.3)
 Behavior expectations are posted (VII.5)
 Healthy lifestyle is promoted (VII.7)
 Administrators and staff hold appropriate credentials (VII.2)
Licensure Data (DOE)
DPAS Data
 All teachers are rated as Effective or Highly Effective and, if not,
there is clear evidence of an IIP or Expectations.
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 5 of 8
Evidence Source
Evidence Details
 Common Planning time is built into the schedule (VII.2)
Comments
Master Schedule
School Newsletters,
Website and Other
Communications with
Parents and Community
 Student exemplary academic work is recognized (VII.3)
 Students are acknowledged for non-academic successes (VII.3)
 Teachers, staff, volunteers, administrators, parents, and
community successes are acknowledged (VII.3)
 Multiple building walkthroughs during class time, transitions,
entering and leaving building reveal orderly and safe environment
(VII.4)
Hallways
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 6 of 8
Evidence Source
Evidence Details
Comments
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 7 of 8
Evidence Source
Evidence Details
Comments
Document Review Worksheet for School Environment
*Note: other sources of evidence may be available. The evidence details above are only suggestions and can be expanded upon.
Page 8 of 8